Smoking Cessation Flashcards

1
Q

List the 5 A approach to smoking cessation

A
Ask if patient smokes
Advise Patient to quit
Assess willingness to quit (stages of change)
Assist in quit attempt
Arrange for follow up
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2
Q

What / How often do you Ask if the patient smokes?

A

Ask EVERYONE whenever you can

Ask if they’ve smoked within the last 6 months

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3
Q

What are 3 considerations in your messaging when advising a patient to quit smoking?

A

Advice must be CLEAR, STRONG, PERSONALIZED

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4
Q

What are the 5 R’s when Assessing a patient’s willingness to quit?

A
Relevance to the patient
Risks of smoking
Rewards of quitting
Roadblocks to quitting
Repetition q 6 – 12 mo
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5
Q

List 5 risks of smoking

A
Cancer
Heart Disease
Stroke
COPD
Complications in pregnancy
Second Hand Smoke
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6
Q

List 5 rewards to quitting tobacco smoke

A

Leading cause of preventable death
Financial gains (1ppy = $3650 per year)
Reduce risks of erectile dysfunction
8h - Carbon monoxide eliminated
24h - Risk of heart attack begins to drop
2w - Improved in lung function, walking easier
1mo - Decreased coughing, nasal congestion, shortness of breath
1y - Risk of coronary heart disease halved
5y - Risk of stroke same level as non-smokers
10y - Risk of mouth, throat and esophageal cancer halved, death rate from lung cancer also halved
15y - Risk of heart attacks similar to that of non-smokers

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7
Q

List 5 elements of tobacco smoking history

A
Treatment preferences
Smoking History
Quitting History
Current meds
Contraindications
Pregnancy
Mental Illness
Substance Use Disorder
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8
Q

Describe the STAR method of Assisting Tobacco smoke cessation

A

Set a quit date within 2 weeks - 30 days. Total abstinence is better than reduction.

Tell friends and family, co-workers, request support.

Anticipate challenges that patient will face. Advised withdraw symptoms. Discuss triggers. Highest relapse within 3 mo of quitting.

Remove all tobacco products, recommend counselling programs and medications.

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9
Q

List 3 first line pharmacotherapy treatments

A

Varenicline (Champix)
Bupropion (Zyban)
Nicotine Replacement Therapy (NRT)

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10
Q

Varenicline: How long before quit date do you start? How long is treatment usually? List S/E, what conditions must you take caution with?

A

Start med 1 week before quit date
12-week course
Caution in renal failure, depression, suicide
ADR: insomnia, nausea, abnormal dreams

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11
Q

Bupropion: How long before quit date do you start? List S/E. What are contraindications?

A

Begin 1 w before quit date and 150 mg / d, then 150 mg BID
C/i: seizure disorder, eating disorder, MOA inhibitor
ADR: insomnia, headache, dizzy, xerostomia, increased BP

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12
Q

List 3 types of nicotine replacement therapies. With what conditions must caution be taken?

A

Patch, Gum / Lozenge, Inhaler

Caution in CVD , post MI.

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13
Q

List 2 second line treatments

A

Clonidine

Nortriptyline

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14
Q

How long before quit date do you start clonidine? What are S/E?

A

Start 3 d prior to quit

S/E: dry mouth, dizziness, sedation, constipation, decreased BP

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15
Q

How long before quit date do you start Nortriptyline? What are S/E?

A

Start 1028 d prior to quit date

sedative, dry mouth, blurred vision, retention

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16
Q

Describe a non pharmacologic treatment. How many, how long?

A

Brief Intervention / Telephone counselling:
4+ counselling sessions > 10 min
6 -12 mo follow up.

17
Q

Treatment for pregnancy

A

Encourage to quit without meds

Intermittent nicotine instead of patches if necessary

18
Q

Treatment with concurrent / hx of depression

A

Bupropion, Nortriptyline

19
Q

Treatment with wt gain

A

Bupropion, 4 mg gum + lozenges

20
Q

Treatment for pt with CVD

A

Still use NRT - patch is safe